Rohrer James E, Rasmussen Norman, Adamson Steven A
Mayo Clinic Department of Family Medicine, Rochester, MN, USA.
J Eval Clin Pract. 2008 Feb;14(1):65-9. doi: 10.1111/j.1365-2753.2007.00797.x.
The purpose of this study was to estimate the independent effect of clinical severity on visit utilization by family medicine patients so that disease management programmes can be targeted accurately and immediately towards patients most likely to benefit from them.
A convenience sample of 698 primary care patients was analysed. All patients had been referred to a medical specialist. Utilization of all types of medical services including laboratory, radiology and ancillary services was used to classify patients as high-utilizers (the top 20%) or not high-utilizers. Patients were stratified into three severity categories based on point scores assigned to specific diseases. The diagnoses included in the Charlson severity index were used to score each patient and the Charlson point scores were used to measure severity. The odds of being a high-utilizer were adjusted for severity category and demographic variables.
Severity was independently related to the odds of being a high-user (adjusted odds ratio = 2.7 for severity = 1 and 5.7 for severity = 2, with the reference category being severity = 0). Age was related to high-use in univariate analyses but not in multivariate analyses.
Case management programmes in primary care practices should consider using disease severity to identify cases. Severity data can be abstracted by medical secretaries who review narrative problem lists as well as billing codes.
本研究旨在评估临床严重程度对家庭医学患者就诊利用情况的独立影响，以便疾病管理项目能够准确且及时地面向最可能从中受益的患者。
分析了698名初级保健患者的便利样本。所有患者均已被转诊至医学专科医生处。利用包括实验室、放射学及辅助服务在内的所有类型医疗服务，将患者分类为高利用者（前20%）或非高利用者。根据特定疾病的评分将患者分为三个严重程度类别。使用纳入查尔森严重程度指数的诊断对每位患者进行评分，并使用查尔森评分来衡量严重程度。对高利用者的几率进行调整，以考虑严重程度类别和人口统计学变量。
严重程度与成为高利用者的几率独立相关（严重程度为1时调整后的优势比 = 2.7，严重程度为2时为5.7，参考类别为严重程度 = 0）。年龄在单因素分析中与高利用相关，但在多因素分析中不相关。
初级保健机构的病例管理项目应考虑利用疾病严重程度来识别病例。医疗秘书在审查病历问题清单及计费代码时可提取严重程度数据。
